Provider Demographics
NPI:1093497463
Name:IBRAHIM, GEORGE EYAD (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EYAD
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 KENRY WAY
Mailing Address - Street 2:
Mailing Address - City:S SAN FRAN
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5508
Mailing Address - Country:US
Mailing Address - Phone:650-773-3411
Mailing Address - Fax:
Practice Address - Street 1:1760 SOLANO AVE STE 309
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2218
Practice Address - Country:US
Practice Address - Phone:510-527-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist